Nobody Told Me: Challenges After Childbirth -- Sylvia Brown -- 10/23/2003

Last Editorial Review: 10/19/2004

By Sylvia Brown
WebMD Live Events Transcript

All the planning for that big day when baby arrives makes it easy to forget about the challenging days and months after delivery. Author Sylvia Brown addresses these potential physical, sexual, and emotional pitfalls in The Post-Pregnancy Handbook. She joined us on Oct. 23, 2003 to talk about what nobody told you.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University: "Bootie Camp: A 4-Week Guide to Baby's First Year." Sylvia Brown, author of The Post Pregnancy Handbook. Today she will answer your questions about the first year after giving birth. You may send in your questions at any time during the event.

Support for this WebMD University course provided by Blue Cross Blue Shield of Massachusetts.

Welcome to WebMD University, Sylvia. What was the biggest surprise you experienced after giving birth?

Brown: My biggest surprise was physical pain. I thought that after childbirth I would be marching off into the sunset with my new baby. But the combination of a big episiotomy, major forceps, and hemorrhoids was almost unbearable. Nobody gave me any ideas for what I could do to ease the pain, and I discovered that running water over the wounds was very helpful. I ended up taking 14 showers on my first day after childbirth.

Later after doing research for the book, I discovered there are all kinds of things you can do to ease pain in the genital area, some with heat and some with cold, and different women find heat or cold to be more helpful, depending on what their problem is.

For example, pouring cold water or ice water over the perineum or filling a latex glove or an examination glove with water and asking the nurses to put it in the freezer are two good ideas. There are also special sanitary gel pads available on the market, which can be kept in the freezer. One is called the Femme Pad, which feels wonderful. Other women prefer heat to soothe the wound and some hospitals will provide a heat lamp.

Also, it's important to keep the area very clean and to pour water over it and clean it gently every time you go to the bathroom.

Moderator: Giving birth triggers hormonal changes -- how do those affect a new mom?

Brown: The key to understanding the effect of hormonal changes is that hormonal levels drop precipitously the minute the baby is born and the placenta is expelled, because the placenta was the hormone production factory in the body. So the reason different women react differently after childbirth really depends on how their body will cope with the change or the drop in hormonal levels, not with the actual amount of hormones in their body.

The best-known effect of this drop in hormones is the effect on your mood, but there are many other hormones that were present during pregnancy. For example, relaxin is the hormone that increases the size and elasticity of muscles in the body and helps you to deliver your baby. That hormone takes about five months to leave your body, so for five months you're much more prone to sprains and hurting yourself than you would be normally.

Some hormones increase your appetite. Prolactin, the hormone that causes milk production is an appetite stimulant.

So while the absence of some hormones have one series of effects, the continued presence of others almost keep you in a pregnant state.

Member question: I feel like I'm on the verge of crying so often. I wanted my baby and I love her, but I feel so fragile and tired. What is going on with me?

Brown: Eighty percent of new mothers feel exactly like you do in the first two weeks after childbirth. This is known as baby blues and is due to the drop in hormones, and simply to the newness of the situation. It will go away. However, if you still feel on the verge of tears for several months after childbirth, you may be experiencing postnatal depression.

The challenge is to determine whether you're just overly tired, possibly anemic, or lacking in some vitamins, or whether you are actually experiencing depression.

If this is your case, you need to talk to a professional to determine whether you could use some medication or whether you just need to reorganize your life and take some vitamin supplements to get over the fatigue that is causing your tears.

Member question: How long after giving birth do I need to keep taking prenatal vitamins?

Brown: Please keep taking your prenatal vitamins for at least two months after giving birth. I'm delighted that you are doing so, because many women don't realize how depleted their vitamin stores are and how essential it is to keep taking prenatal vitamins after birth.

Member question: Do you know if anything works to reduce the visibility of C-section scarring?

Brown: First of all, it takes time. You probably will need about a year for your scar to disappear. It may itch for up to five months after your delivery. It may suddenly become red before shrinking to its permanent shape about eight months after the surgery.

In your first few weeks at home, you should be particularly careful about hygiene and caring for your scar. You can rub vitamin E oil or almond oil on it, or apply a poultice of green clay, which is available in health food stores, to the scar once it's completely healed. Also, do not expose the scar to direct sun for a year.

Member question: This may seem petty vain, but I really want to get rid of these stretch marks. What works?

Brown: Stretch marks will gradually narrow to fine white lines, but it will take time. If your stretch marks are still highly visible six months after delivery, you might consider dermabrasion or vitamin A acid cream, or even plastic surgery in extreme cases. All of these should be done under the supervision of a doctor. Please do not try any unlicensed techniques, as they probably will do you more harm than good.

Member question: Nobody told me that after the initial excitement everyone would go back to normal except me. The baby is four weeks old and sleeps much of the time, except she wakes up so often that I am not getting the sleep I need. My mom says to be patient, that babies really get their cute personalities when they are little older. I don't know what I was thinking, but I feel tired and isolated.

Brown: Most women do not plan sufficiently ahead. Having a baby is not marching into the sunset. Before you go into the hospital, organize a network of friends and family to help you with housework, with babysitting, and to ensure that you will have some time for yourself, some time to get out of the house, and time to nap.

  • Ask friends to come cook you dinner and do the dishes.
  • Ask friends to hire a housekeeper or a baby nurse for a few hours, rather than give you clothes for the baby.
  • Team up with other new mothers that live nearby and take turns watching the two babies so one of the mothers can have some time off.

Planning and prevention are the best cures for fatigue. Recreation is also very important. And make sleep a priority. Nothing is more important than sleep, so whenever you can, nap.

Member question: My friends are all at my old job. None of them are parents yet. I feel a bit disconnected from them. Any advise?

Brown: You will soon begin to make new friends with other new moms. There probably are new mother groups in your community that you can attend, or other ways for you to meet these new moms. You will find endless topics to discuss together, because you now have so much in common.

Having a baby is an intricate into a new life and a great opportunity to expand your network of friends. The hospital or birthing center may have addresses of parenting groups. If you look in some of the free community parenting newspapers there might be some names and addresses. Also, churches provide new parent groups.

Member question: I was planning to return to work but now I can't stand the thought of being away from my child. Should I tell my boss now or wait until my leave is almost over?

Brown: Much depends on your company's policy, but you need to decide what the costs and benefits are of telling your boss now as opposed to waiting. Some things to think about:

  • How much advance notice do you need to give them?
  • Have you been replaced by someone temporary?
  • Were you in the middle of a major project that needs to be finished? Are there things you could be doing from home?
  • Will your boss be upset and give you a bad reference?

Member question: How did you handle all the relatives and friends that wanted to come right over and celebrate the new baby? We want to have time to bond and cocoon a little before exposing the baby to all those people (and their germs). How do we announce this diplomatically?

Brown: You are so right. Use your husband/partner as the watchdog and bodyguard. Men usually love this role. Why not plan a celebration in a few weeks when you feel up to it, or institute visiting hours, a time maybe in the afternoon twice a week when people are welcome to come over. But make sure they know these hours are limited. Get the word out that you don't want people to drop by unannounced. Screen your phone calls using your answering machine.

Moderator: Some people post pictures on the Internet with a guest book so that virtual visits are possible. This allows everyone to coo over the baby in a safe way until you are ready to have real guests.

Member question: I was surprised by the gurgling, wheezy sounds our baby made the first few weeks. We always thought she was choking! Did you worry a lot about your baby's breathing?

Brown: Obviously if you have any concerns, consult a health professional, but you will find, after a few weeks, that you know your baby's sounds and your mother's instinct will tell you when something's not normal. Remember, it takes time to get to know this little person, but within just a few weeks, you will feel much more comfortable and much less apprehensive.

Member question: Can you talk about diet after childbirth? I want to nurse but I also want to get back to proper weight.

Brown: Right after childbirth your body needs to recover. Your iron and vitamin and mineral stores have been depleted. Seventy percent of new mothers are anemic. Therefore, you shouldn't think of dieting for two to three months after childbirth.

Immediately after the baby is born, you will lose about 11 pounds. You will then lose 9 to 11 more pounds over the next few weeks in fluids, a shrinking uterus, etc. Then your goal should be to lose no more than one to two pounds a month for the first six months. Losing more than 4 1/2 pounds a month is unsafe.

Different women lose different amounts of weight after childbirth:

  • Skinny moms who gain 30 to 35 pounds lose most of their pregnancy weight in the first three months.
  • Borderline overweight, older moms, third- or fourth-time moms who gain between 35 and 75 pounds, lose most of their weight between the third and sixth month. It is especially important for these moms not to remain more than a few pounds over their pre-pregnancy weight.
  • Overweight moms will lose most of their excess weight 6 to 9 months after childbirth.

So weight loss takes time. The key to remember is to eat right. You need to keep your energy levels up and you need to keep your serotonin levels up (these are the neurotransmitters that determine your mood) with a diet rich in complex carbs. This is not the time to go on a protein diet. You should be eating about 2000 calories, 50 to 60% of which should be complex carbs, 25 to 30% of which should be fat, and 20% of which should be protein.

If you are breastfeeding, you are burning 750 extra calories, so you should be eating 2,500 calories a day and you need 12 to 15 grams of extra protein. This means two glasses of milk or two extra eggs. Breastfeeding is not a weight loss guarantee, because for the first four months, prolactin, the hormone that stimulates milk production, also stimulates appetite and breastfeeding women tend to retain fluid.

The good news is that after four to six months, prolactin levels drop, but a breastfeeding mother's metabolism retains high. This means her body will burn fat and this is the one time in a woman's life where she will burn the fat in her thighs. So stick with breastfeeding for more than four months and it will be beneficial to your weight loss.

The bottom line is you need to eat right with as many fresh foods as possible, watching your calorie intake, but do not diet.

Member question: How soon after giving birth does your period start again? And do you go back to having the same kind of cycle as before pregnancy? Friends have told me that after childbirth, cramps are lessened.

Brown: Each woman is different. Some women find that they no longer have cramps; others claim there is no change. If you are not breastfeeding, you generally will start menstruating six to eight weeks postpartum. If you are breastfeeding, you may not menstruate until you wean the baby. Other women get their period back but continue to breastfeed. Your first period after childbirth is often much heaver and lasts longer than usual.

Breastfeeding is not a form of contraception. It is the sensation of the baby sucking that sends a message to the brain to suppress the hormone that stimulates ovulation. This means that the baby needs to be almost continuously sucking for the brain to block ovulation. In Western societies, most women do not go around with the baby at their breast all the time.

In some cases if the baby sucks its thumb or a pacifier, this may be enough to diminish the intensity of his sucking.

Member question: How long after giving birth should you wait before resuming your love life?

Brown: Generally, doctors will give you a green light about six weeks after childbirth, but remember your genital organs and your reproductive system are not fully healed until two months after childbirth. A lot depends on your scars, how sore you are, how tired you are, whether you're having problems with lubrication, and whether you might still be bleeding.

Many women feel that the baby satisfies their need for intimate contact for quite a while after childbirth. Others find their sex drive returns fairly quickly. The most important thing is not to rush it. This means having a heart-to-heart discussion with him before the baby is born, warning him you may not be feeling like having sex for quite a while after childbirth, and keeping him informed about your feelings once the baby is born.

Resuming sex after childbirth is above all, a question of patience. Once you are ready, you will need extra lubrication and you will need to go at it very gently and slowly, because it's almost certain to be a little painful the first few times. If you find the pain unbearable, please, please consult a professional health practitioner.

Member question: I know a couple who had some intimacy problems after their baby was born because he suddenly looked at her as a mommy, not as someone you have sex with. Is this a common reaction from men?

Brown: This is a very common reaction. The most important thing you can do is talk to your husband/partner before the baby's birth about how things are going to change. Men often complain about being caught unaware and not being warned about how the relationship will change. Make sure that your husband/partner understands that while you are a mother, you are also a woman and he needs to recognize that you are capable of being both, and that it is important for your self-esteem that you are seen as both. This is where good communication really pays off.

Member question: I seem to remember certain exercises we were told to do after giving birth to strengthen the pelvic floor. Is that still a concern?

Brown: It is absolutely vital that you tone your pelvic floor after childbirth, even if you had a C-section. During pregnancy the weight of your uterus increased 20 to 30 times. The ligaments holding up your organs were weaker. Childbirth stretches and distends your pelvic floor, which loses 50% of its tone. The sphincters don't work as well and your organs are less well suspended. You prepared for nine months to open up; now you need to close up. This is also vital for the quality of your sex.

There are a number of gentle exercises you can do to tone your sphincters, but you must do them during the first six weeks after childbirth and you must not start exercising until your pelvic floor is toned and fit again. If not, you risk incontinence later in life or organ prolapse. Forty to 50% of women experience urinary incontinence at some point in their lives. One in 4 experiences stress incontinence after childbirth. That's leaking urine after a cough or a sneeze or a laugh.

I recommend waiting six to 10 weeks before starting exercise. Walking and swimming are the best exercises. You can start toning about 15 minutes at a time two months after childbirth, building up by five minutes a week. Bicycling, tennis, and low-impact aerobics should wait until four to five months after childbirth when the hormone relaxin has completely left your body, when your pelvic floor is strong again, when you are less fatigued, and when you are ready to take on the demands of an exercise program.

Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Sylvia Brown for sharing her expertise and experience with us. For more information, please read The Post Pregnancy Handbook, by Sylvia Brown and The Mother of All Baby Books by our "Baby Bootie Camp" University course instructor, Ann Douglas.

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